Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing

Abstract

Four hundred avulsed and replanted permanent teeth were examined for pulpal healing. In 110 teeth, the apical foramen was either open or half-open. In 16 teeth, the pulps were extirpated prophylactically. Thus, pulpal revascularization was considered possible in 94 teeth. Revascularization occurred in 32 teeth (34%). Pulp necrosis could usually be demonstrated after 3 weeks. Positive pulpal sensibility and radiographis signs of pulp canal obliteration were usually observed after 6 months. The effect of various clinical factors was examined, such as sex, age, type of tooth replanted, stage of root formation, type and length of extra-alveolar storage, clinical contamination of the root surface, type of cleansing procedure of the root surface, type and length of splinting and the use of antibiotics. Finally, the width of the apical foramen and the length of the root canal were measured on radiographs taken at the time of injury. A multivariate statistical analysis revealed that pulpal revascularization was more frequent in teeth with shorter distances from the apical foramen to the pulp horns. Furthermore, that wet storage (saliva and/or saline) for more than 5 min decreased the chance of pulpal revascularization; whereas dry extraalveolar storage had a monotonous effect on pulpal revascularization, i.e. decreasing chance of revasculatization with increasing length of the extraalveolar dry storage. Based on these findings, immediate replantation after brief cleansing in either tap water or saline is recommended.